Marc Ó Cathasaigh (Waterford, Green Party)
Link to this: Individually | In context | Oireachtas source

325. To ask the Minister for Health if his attention has been drawn to the recent ESRI report entitled "Changes and challenges facing the Irish long-term residential care sector since COVID-19"; his plans to address the disparity between funding for public and private nursing home providers; his plans for Budget 2025; if increases to Fair Deal funding are needed to match inflation; and if he will make a statement on the matter. [25915/24]

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Government is aware of the investment trends in the Irish residential care market, the growing consolidation of the sector, and the complex investment and ownership structures that now exist.

I welcome the recent publication of the ESRI report ‘Long-term Residential Care in Ireland: Developments since the onset of the Covid-19 pandemic’ which brings into focus the challenges facing the long-term residential care sector in Ireland that the Government has been, and continues to, address to provide short-term stability and long-term growth to this sector.

In the context of the ongoing reform of older persons services, including long-term residential care, over the coming years, it is important that all aspects of the nursing home sector continue to be scrutinised. I am committed to ensuring that service delivery and configuration in the sector meets the needs of service users in a sustainable and safe manner.

The Government is conscious of the financial challenges faced by the nursing home sector, especially smaller and voluntary nursing homes that may not have access to the same economies of scale as larger homes or groups.

I have regular meetings with private nursing home provider representative groups where the issues of Government policy and support for the sector are on the agenda. I have committed to continued engagement with the sector.

The Department of Health acknowledges that there are variations in the cost of care across public centres as well as across private nursing homes. HSE operated Community Nursing Units (CNUs) generally having a higher cost of care.

In December 2021, the Department published the independently chaired Value for Money (VFM) review on nursing home costs. The review found that the cost differential is largely driven by variances in staff-to-resident ratios and the skill mix in public and private nursing homes.

The VFM Review made nine recommendations which the Department continues to take forward.

Residents in HSE-run Community Nursing Units (CNUs), which are often staffed at a level that allows the delivering of more complex care where required, represent less than 20% of Fair Deal scheme participants. Last year, 4,500 residents were in these public CNUs.

The Department of Health also published a review of the National Treatment Purchase Fund (NTPF) pricing system in June 2021 and, in cooperation with the NTPF, continues to work on bringing forward the recommendations that emerged from this review.

The NTPF is the body designated, under Section 40 of the Nursing Homes Support Scheme Act 2009, to negotiate with persons carrying on the business of a nursing home, for the purposes of reaching an agreement on the maximum prices to be charged for nursing home care, and are based on the NTPF’s cost criteria. These criteria include costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity. This is the only mechanism for funding from the public purse for nursing home residents.

I have regular interaction with the NTPF to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed.

A significant change that the NTPF have made to their negotiation process is to offer nursing home providers contracts of a shorter duration, which will aim to ensure that NTPF rate increases stay aligned with any cost pressure increases that occur over the course of the contracted period. This has allowed for more surety in the sector.

As of the end of April, 420 nursing homes have agreements with the NTPF under the Nursing Homes Support Scheme (Fair Deal). The NTPF is expected to negotiate 389 Deeds of Agreement in 2024. For 2023, there were 257 full Deeds renegotiated, with a further number of mid-Deed uplifts in addition to this (this is where Deeds were negotiated with a 2-stage uplift: one at the start and another uplift that comes 6, 12 or 18 months after but still within that Deed of Negotiation). Nursing homes who renegotiated their Deeds of Agreement in 2023 received an average uplift of 6-7%. The average uplift to date in 2024 is 5-6%.

It should be noted that the Nursing Homes Support Scheme (or Fair Deal) was designed to protect and support vulnerable older people, to ensure equal access to nursing home care based on what they could afford. This gives certainty to people and families.

Increases in year-on-year funding for the NHSS continues and will reach €1.5 billion this year. Budget 2023 saw over €40 million in additional funding for the scheme. I am cognisant that the budget must support all participating nursing home residents for the full calendar year.

It is therefore imperative that private and voluntary providers continue to engage in the process as set out in the Nursing Homes Support Scheme Act 2009.

An additional €45.6 million has also been allocated to support nursing homes in Budget 2024, including a new €10 million fund to support private and voluntary nursing homes with HIQA compliance.

The Resident Safety Improvement (RSI) Scheme has been introduced and is designed to target and support structural improvements in nursing homes to assist their meeting HIQA compliance plans in respect of protection against infection and fire precautions. It is active as from 1 January 2024 and can be backdated for eligible works to 1 January 2020.

I recently welcomed the completion of the national rollout of a new community based mobile X-ray service which aims to reduce the number of older patients attending Emergency Departments (EDs). Following a pilot launched in 2022, from 1 March 2024 this free, community-based service is available to all residents in nursing homes and Community Nursing Units nationwide. It should also be noted that a nursing home resident's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. This means that nursing home residents who also have medical cards have the same access to GMS services regardless of whether they reside in their own homes or in a nursing home.

Furthermore, in late February, it was announced that over €3.2 million in State support will be provided for over 440 registered nurses in private nursing homes to obtain a Postgraduate Diploma in Gerontological Nursing.

All of these measures are intended to find the right balance between delivering value to the taxpayer, affordable access to long-term care for citizens and a sustainable nursing home sector which ensures that people who require care can continue to receive high quality services in the most appropriate settings.